How have you decided to have or not have hrt ? What made up your mind ?

[Perimeopausepip]

Just wondering about people’s though process as to weather to take hrt or not ?

im tempted but worried

Same. I'm 52 now and have been doing weights (plus lots of other exercise - including a sport competitively at international level - I'm also a qualified gym instructor) for 30 years. Plus a healthy diet, good sleep hygiene etc.

Despite all this, peri-menopause has been debilitating for me. I also have long Covid and this has badly affected my nervous system (confirmed by some very expensive tests in Harley St) but it turns out that some of the reason why I haven't bee recovering from long Covid was that some of the symptoms were also peri-menopause symptoms. The brain fog combined with chronic fatigue means I can't do my job. I need to earn a living.

So despite being high risk for breast cancer (due to family history - I've been under the care of a breast clinic for almost 20 years now), I started on HRT last Nov. My breast clinician originally freaked out at the idea but when they realised how much I was being impacted, even they agreed that starting HRT was worth the risk. It's not been a full 3 months yet but I am doing much better already. Worse case is I do get breast cancer but I'm willing to accept that risk (after much thought, reflection and discussion with family/friends/medical professionals).

I stopped having periods at 50. I'm 58 now. I ended up finishing work nearly 5 years ago due to brain fog, fatigue and depression. I had no idea that it was the menopause causing it all. What finally prompted me to start HRT 2 weeks ago , was vaginal dystrophy. It became impossible to have sex , plus my sex drive disappeared. There is already a massive improvement. I did pay to see a consultant privately as my GP isn't easy to talk to. It was worth every penny.

I took HRT for some years. I had a premature menopause and my symptoms were absolutely horrendous. HRT helped to some extent, but boy oh boy did I know it if I ever missed a dose.

My mum and sister both turned into old ladies with osteoporosis very early. Mum had dementia and hot flushes til she died. My sister suffered terribly with the menopause and even in her seventies suffers now. That's why I went on HRT as soon as I hit 50 and will stay on it until I die

The problem is there seems to be research to support every view out there.

For example this study:
UK Biobank data
Gong and colleagues analyzed the data of 273,240 women and 228,957 men without dementia who were enrolled in the U.K. Biobank — a prospective population-based cohort — between 2006 and 2010. They assessed participants’ follow-up data from baseline until incidence of all-cause dementia, death or until the cutoff on Nov. 30, 2020.

Found that:
There was no significant difference in dementia risk between women who used HRT or not (aHR = 0.99; 95% CI, 0.9-1.09), or for HRT duration (aHR = 1; 95% CI, 0.98-1.01). However, there was a small reduction in dementia risk with older age at HRT initiation (aHR = 0.96; 95% CI, 0.95-0.98).

The things they found that did make a difference were social deprivation, age of onset of periods (younger than 12 or over 14), having a baby before 21, having a hysterectomy especially if after oophorectomy.

Pregnancy and abortion both reduced the rate as did having a reproductive span of 36 years or longer.

I do think there's some scare stories out there. My grannies didnt have osteoporosis and of my aunts, one took hrt one didn't, neither have osteoporosis and neither has more or less problems or seems older or younger than the other. Plenty of old people are fine without hrt. Anecdotally I personally know of a few scare stories from hrt. And it's not clear how long you're meant to be on it/how and when you are meant to stop. So for me personally there's still a lot of uncertainty around what to do.

Being overweight/obese increases the risk of breast cancer significantly - more than taking HRT. I feel a lot more motivated to go to the gym and address comfort eating now my brain fog has lifted and my joints don't ache all the time.

I had terribe fibroids leading to a hysterectomy. My doctor said I wasn't a good candidate for hrt because over-production of oestrogen had caused the fibroids and as there is a family history of breast cancer I should not have it. I think I prefer going without the hrt as meno symptoms really aren't that bad.

Thank you! That's helpful. I think I have to try at least.

My only concern is the lack of knowledge some GPs have about endometriosis. One even suggested ablation might help (not my GP fortunately).

I chose not to. I eat healthily, exercise and am not overweight.

I do all of those things, especially the exercise, and it's other symptoms like the insomnia, the heat, and to feel more balanced, from a moid point of view, if that makes sense.

Had talk with GP. She outlined pros and cons and the pros are good for everyone and outweigh the cons, which are mostly unlikely to happen. Also, she told me the HRT she was proposing for me (Mirena plus oestrogen gel on the skin) is the safest form.

PS My GP has a special interest in this area

I battled through perimenopause with the attitude that I didn't want HRT and I'd get through it with supplements (Menopace plus various others). However, it didn't stop the aching joints & night sweats, and even topical oestrogen didn't fix the vaginal atrophy. A few months ago, aged 58, I decided I'd had enough and persuaded my GP to prescribe HRT. Oh my goodness - I feel amazing. It's like I've got 'Me' back for the first time in years, no aches and pains, a good sleep every night and a comfortable vagina. Total game changer and I'm planning to stay on it forever if I can.

My grandmothers both lived well into their 90s, no HRT, and did well with health. My mother is in her 70s, no HRT, and doesn't seem to have any issues. So that makes me wonder, how necessary is it for me, do my genes give me a good chance without it?

Also, I'm nearly 50 and still have regular monthly cycles. Does that mean I should wait before considering HRT?

Thank you, that's very helpful. I have topical Ovestin twice a week but it doesn't quite seem to be enough. After years of discomfort in that area, if HRT would work, it might be worth that alone.

@Perimeopausepip why are you worried about liver specifically?

Transdermal hrt, there's no evidence of any liver issues unless you already have established liver disease

As a chronic migraine sufferer, I was advised not to but my default was not to take it anyway.

Its regularly trotted out on here that there is little risk on HRT, but if you read the literature in the HRT, that’s not quite right. I spoke to the GP about HRT and was quoted the risks, yet when I actually read the inserts the chances were higher than she said. Plus I’m over weight and was having the occasional vino.
I just decided that it’s not for me at the moment.
I got a Mirena coil and happily found that it reduced my monthly rages.
I take magnesium at night and that has significant helped my sleep, plus the one I take has helped my meno brain.
Ive stopped drinking and that has stopped my night sweats.
I just preferred to try sorting each symptom. But if I was suffering like others do, I would try it.

I read and listened to Dr Louise Newson and that made my mind up. My headaches were debilitating.

Hot flushes every 15 minutes, day and night, settled it for me. I could feel myself slipping into very deep depression. I've ceased caring about coming off my HRT. My current dr is happy for me to be on it for as long as I need it.

I'm on it and my mood swings and anger have dissipated! Also no longer need to sleep on a towel to catch the night sweats.

Happy to take it as long as is necessary. I know of an 80 year old who still uses the patches as when she tried to come off she felt dreadful.

I have, but I am in my thirties so was a very easy decision for me. Thankfully only positive (very very significant) hoped for ‘effects’ rather than side effects.

(Should add I use estrogen patches)

I was desperate to get some semblance of "normal" back, so debilitating was the combination of insomnia, hot flushes, anxiety and brain fog.
We do have a family history of breast cancer but I'm happy to take that risk. A greater risk was my own mental health.

I could cope with some of the symptoms but for me the sudden onset anxiety and gloom for no reason and the sleep disturbance were reasons I went for it.
After a few weeks I went back to proper sleep and I haven't had any sudden low moods.
I also stopped having bad hip discomfort that was making it hard to sleep as well.

I don't take it as my symptoms were fairly mild and, back then, it was used less as the risks were thought to be higher
I am a bit concerned that women are being encouraged to medicate themselves at a very low threshold now. Who knows the long term effects of years of the pill and then years of HRT? They may be positive but we don't have evidence of that yet, hence all the publicity says "possible benefits"